Correlation between Serum Albumin Level and Severity of Acute Ischemic Stroke - A Prospective Observational Study from Trivandrum, Kerala

Abstract

BACKGROUND Preclinical studies have shown a neuroprotective effect of albumin in acute ischemic stroke (AIS). Owing to the scarcity of clinical studies establishing the correlation of serum albumin levels and AIS, the present study was conducted using National institute of health stroke scale score (NIHSS). METHODS The present prospective observational study evaluated the association of serum albumin and NIHSS score at baseline, 1 week, 1 month and 3 months of admission in 18 participants aged 18 years or more admitted within 48 hours of AIS in Internal Medicine Department of Government Medical College, Trivandrum between 2019 and 2020. Participants with transient ischemic attack, atrial fibrillation, decompensated cirrhosis of liver, nephrotic syndrome, hypoalbuminemia, hypercholesterolemia, and intracranial hematoma were excluded. Institutional Ethics Committee approved the project and written informed consent was obtained from all study participants. Serum albumin was estimated using enzyme linked immunosorbent assay (ELISA) kit using standardized technique. Logistic regression was used to determine the association of albumin and NIHSS. Analysis was done using R and p < 0.05 was considered statistically significant. RESULTS The mean age of study participants was 60.2 (12.9) and 55.6 % participants were males. 11.1 %, 5.6 % and 22.2 % participants had history of ischemic stroke, chronic kidney disease, and coronary artery disease respectively. At baseline serum albumin was 3.5 (1) g/dL and NIHSS was 13.2 (9.3). Negative correlation between serum albumin and NIHSS scale at baseline (r = -0.873, p < 0.01), at one week (r = - 0.856 and p < 0.01), at one month (r = -0.856 and p < 0.01) and three months (r = - 0.856 and p < 0.01) was observed. CONCLUSIONS Lower serum albumin level was associated with severe neurological deficit and had worse outcomes in patients with acute ischemic stroke. Albumin can be used as an easy, inexpensive, rapid, and reliable tool in determining the prognosis of AIS. KEY WORDS Serum Albumin, Acute Ischemic Stroke, Outcome, Prognosis, NIHSS